Comprehensive Patient Blood Management: An Urgent Need for a New Clinical Strategy

Posted on: March 13, 2018

Published studies suggest that 40 to 60 percent of all blood transfusions may be unnecessary, excessive or avoidable. Blood transfusion is one of the most common medical procedures performed at Mercy Medical Center with approximately 9,000 transfusions administered annually. Growing evidence continues to associate transfusion with a higher incidence of infections, renal injury, pulmonary injury, myocardial infarction and mortality.

Mercy Medical Center is implementing a comprehensive Patient Blood Management (cPBM) Program. This program is reflective of a national patient safety initiative focused on evidence-based transfusion practice and proactive strategies designed to avoid transfusion risk (anemia management and minimize blood loss). Mercy has partnered with Accumen, a national leader in patient blood management to help the organization focus and accelerate current PBM efforts. Over the next couple of months, please take notice of significant changes to transfusion guidelines and transfusion ordering practices.

Important themes include:

Transfusion is a transplant – Blood transfusions are a liquid “transplant” that can impact short and long-term patient outcomes. Unnecessary and avoidable transfusions cause measurable harm.

LESS is more for transfusions – Evidence for transfusion therapy indicates that a more restrictive threshold for RBC transfusion (Hbg <7 g/dl) not only saves blood but also saves lives.

Why give two when one will do! – In the absence of acute hemorrhage, RBC transfusions should be ordered as single units followed by a reassessment prior to any additional transfusions.

Modified CPOE transfusion ordersets – The Meditech transfusion ordersets have been updated to reflect best practice to optimize transfusion indication selection and dosing.

Updated 2018 MMC Transfusion Guidelines – The 2015 guidelines received a significant overhaul and reflect the best available evidence. Read the 2018 guidelines here. Updated guidelines are also posted on MercyNet.

If you would like more information about Mercy Patient Blood Management Program, please contact Katherine Simmons, R.N., program coordinator or Kirby Sweitzer, M.D., medical director.